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Editor - Captain L. B. Marshall, MC, USN (RET) 



Vol. 25 



Friday, 18 February 1955 



No. 4 



TABLE OF CONTENTS 



Opportunity for Residency Training . . . 2 

Diagnosis of Pernicious Anemia 3 

The Guillain-Barre Syndrome 5 

Probenecid ' 

Acute Transient Middle Lobe Disease 9 

Treatment of Cardiovascular Disease with Anticoagulants 10 

Ultraviolet Microscopy of Renal Vascular Diseases 11 

Improved Method for Skin Graft Coverage of Extensive Burns 13 

Benign Ulcers of the Greater Curvature of the Stomach 15 

Tracheo -Esophageal Fistula Due to Blast Injury 16 

Aneurysmal Bone Cysts 18 

Aviation Medical Acceleration Laboratory, Johnsville, Pa. 19 

Change of Address 20 

'A Letter" 21 

'Honors" 21 

Retirements 22 

Training Course in Field Medicine 22 

From the Note Book 23 

Board Certifications 2 $ 

Recent Research Projects 2 ? 

Protective Clothing Set (BuMed Notice 6780) 28 

Defective Medical and Dental material (BuMed Instruction 6710.12). . . 28 

Sick Call Treatment Record (BuMed Notice 6150) 29 

Cancer Information (BuMed Notice 6300) 29 

Outpatient Report (BuMed Instruction 6320. 9B) 30 

AVIATION MEDICINE DIVISION 

3.5 In '55. 30 West Coast Flight Surgeons. .. . 38 

Aviation Medicine Certification. . 33 SF-88's and SF-89's 39 

Aero Medical Association Meeting 36 Aviation Medicine Practice. ... 40 



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Medical News Letter, Vol. 25, No. 4 



Policy 



The U.S. Navy Medical News Letter is basically an official Medical 
Department publication inviting the attention of officers of the Medical De- 
partment of the Regular Navy and Naval Reserve to timely up-to-date items 
of official and professional interest relative to medicine, dentistry, and 
allied sciences. The amount of information used is only that necessary to 
inform adequately officers of the Medical Department of the existence and 
source of such information. The items used are neither intended to be nor 
susceptible to use by any officer as a substitute for any item or article in 
its original form. All readers of the News Letter are urged to obtain the 
original of those items of particular interest to the individual. 

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Notice 



Due to the critical shortage of medical officers, the Chief, Bureau of 
Medicine and Surgery, has recommended, and the Chief of Naval Personnel 
has concurred, that Reserve medical officers now on active duty who desire 
to submit requests for extension of their active duty for a period of three 
months or more will be given favorable consideration. 

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Opportunity for Residency Training in the Navy 

Applications for residency training are requested from Regular 
officers and those Reserve officers who have completed their obligated 
service under the Universal Military Training and Service Act, as amended. 

Training is available for Regular officers in all of the major medical 
specialties. It is available for Reserve officers in Pathology, Orthopedic 
Surgery, Obstetrics and Gynecology, Pediatrics and Urology. There are 
a few billets available for training in civilian hospitals in the specialties 
of Anesthesiology, Otolaryngology, Dermatology and Syphilology. 

Residency training may be started immediately on completion of 
internship. It is now the desire of the Bureau of Medicine and Surgery 
to continue a resident in training without interruption until he has com- 
pleted the formal training requirements leading to certification by an 
American Specialty Board. The procedure will be strictly adhered to in 
every case where the demands of the service permit and providing the 
trainee shows satisfactory progress. 



$ * $ sjc $ $ 



Medical News Letter, Vol. 25, No. 4 



3 



Diagnosis of Pernicious Anemia 

Pernicious anemia, as it is encountered in present-day practice, 
rarely conforms to the descriptions found in textbooks. As a result, the 
diagnosis is sometimes difficult to establish. There is no chronic disease 
which is more easily or more satisfactorily treated, but early recognition 
and adequate therapy are essential if the patient is to be protected against 
permanent crippling disability. 

Pernicious anemia is no longer pernicious nor is it primarily a blood 
disorder. The manifestations of the disease are attributable to deficiency 
of vitamin B^. the result of inadequate absorption of the vitamin from the 
gastrointestinal tract. The basic lesion is found in the stomach, which has 
undergone an atrophic change and fails to secrete hydrochloric acid and the 
gastric enzymes. "Intrinsic factor, " a component of normal gastric secre- 
tion, is not produced by the stomach of the patient with pernicious anemia. 
As yet unidentified, "intrinsic factor" is required for the absorption of 
optimal amounts of vitamin In its absence, vitamin Bj£ is inade- 

quately absorbed even though ingested in usual amounts. 

Vitamin B^ deficiency leads to a generalized physiologic disturbance, 
but three organ systems are predominantly involved: (1) the alimentary 
canal is affected. (2) Bone marrow function is disturbed. (3) The nervous 
system is involved in an important way. 

There is no regular relationship between the times of appearance 
of the alimentary, hematologic, and neurologic manifestations. Some 
patients develop soreness of the tongue long before the blood becomes 
abnormal. Others have symptoms of anemia in the absence of alimentary 
or neural complaints. Still other patients develop the neurologic disorder 
at a time when the blood and bone marrow are entirely normal. Any com- 
bination of these manifestations may occur. 

Administration of vitamin Bj2> "which is now known to be the active 
component of liver extract, does not restore the function of the stomach. 
The absorption defect persists, and, therefore, it is necessary to con- 
tinue treatment throughout the life of the patient. As a result of adequate 
treatment, most patients regain normal health, the blood and bone marrow 
are normal, alimentary symptoms are absent, and neurologic manifesta- 
tions do not develop. 

During remission, the diagnosis of pernicious anemia is virtually 
imposssible. If therapy is withheld, relapse will occur, but it is not 
unusual for remission to be maintained for a year or two after all treat- 
ment has been discontinued. 

The absorption defect in pernicious anemia is readily circumvented 
by parenteral administration of the vitamin. Amazingly small amounts 
suffice. An injection of 50 meg. of vitamin B^j given once each six weeks, 
provides adequate maintenance therapy. 



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Medical News Letter, Vol. 25, No. 4 



The general availability and injudicious use of liver preparations, 
vitamin B^, ana - folic acid have led to a high incidence of incorrect diagnose 
and inadequate treatment in recent years. 

The early symptoms of pernicious anemia include fatigue, weakness, 
soreness of the tongue, mild gastrointestinal disturbances, and numbness 
and tingling of the hands and feet. A patient who develops one or the other 
of these symptoms is very likely to receive a multivitamin preparation 
without appreciation of the correct diagnosis. If the preparation contains 
folic acid, anemia disappears before it is recognized to be present, alimen- 
tary symptoms subside, and the patient often feels much improved. Weeks 
or months later, however, progressive neurologic disease will become 
apparent and may incapacitate the patient while the blood remains normal. 
At this time, the physician often does not think of pernicious anemia, but 
considers the diagnosis of multiple sclerosis, cord tumor, or some other 
neurologic disease. Because the diagnosis is not recognized, the patient 
may be deprived of the simple therapy which could have maintained him in 
excellent health. 

Since the use of folic acid has become widespread, almost half of 
the new patients with pernicious anemia, seen at the Johns Hopkins Hospital, 
arrive with neurologic disease in the absence of an appreciable degree of 
anemia. Folic acid deficiency is extremely rare in the United States, and 
the indiscriminate use of this vitamin is not justified. Under no circum- 
stances should folic acid in any form be administered to a patient whose 
symptoms might be those of pernicious anemia. 

When a patient is found to have anemia, it is of the greatest impor- 
tance to determine the cause before initiating therapy. Injection of liver 
extract or vitamin B^, or administration of an oral hematinic preparation 
containing folic acid, will lead to prompt improvement in the hemoglobin 
level in patients with pernicious anemia. If the diagnosis of pernicious 
anemia has not been established before instituting such therapy, the phys- 
ician fails to recognize that life -long therapy is required. Often, there- 
fore, the treatment is discontinued after the patient appears to recover. 
Relapse inevitably occurs and neurologic manifestations may appear. 

One of the most valuable diagnostic tests available, in dealing with 
anemia, is the demonstration of response to specific therapy. Dramatic 
response of an anemia to the injection of vitamin B^ provides convincing 
support for the diagnosis of pernicious anemia. This diagnostic test is 
of no value if "shotgun" preparations are used. It is rare that more than 
one specific anti-anemic substance is required in the treatment of a patient 
with anemia, and under no circumstance is the combination of vitamin Bj2» 
folic acid, and iron in the same preparation acceptable. 

The syndrome of subacute, combined degeneration of the spinal cord 
should always be considered to be pernicious anemia even though the blood 
and marrow are normal. Failure to treat patients with this disorder leads 



Medical News Letter, Vol. 25, No. 4 



5 



to irreparable damage to the nervous system. Even when improvement does 
not occur, further progress of the disease is arrested by adequate therapy. 

No existing treatment for pernicious anemia is superior to the regular 
parenteral administration of vitamin B}2 or refined liver extract. Most 
preparations designed for oral use are completely inadequate. Recently, 
oral preparations have become available which combine vitamin Bi2 with 
"intrinsic factor" in an effort to enhance the absorption of the vitamin. The 
amount of vitamin B^2 which can be absorbed from such preparations is 
much smaller than that which can be injected. Furthermore, prolonged 
studies have not yet been carried out to determine the optimal maintenance 
dose. Therefore, the use of such preparations is experimental and cannot 
be recommended for general use. (GP, Jan. , 1955; C. L. Conley, M. D. , 
Johns Hopkins University and Hospital, Baltimore, Md. ) 

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The Guillain- Barre Syndrome 

Prompted by the apparently increasing interest in the Guillain-Barre 
syndrome, the authors considered it appropriate to review 17 cases of this 
clinical complex observed at Grasslands Hospital. 

Since 1859, when Landry made what was probably the first descrip- 
tion of this condition, few factual data have come forth to dispel the obscur- 
ity surrounding its cause. Specific toxins, viruses, and bacteria, as well 
as dietary deficiencies, heavy-metal poisoning, and circulatory disturbances 
have been blamed. This symptom complex has been reported in association 
with, or subsequent to, many dis similar entities: acute nonspecific upper 
respiratory infections, pneumonia, various encephalitides, measles, mumps, 
scarlet fever, influenza, varicella, botulism, tuberculosis, syphilis, infec- 
tious hepatitis, infectious mononucleosis, sulfonamide poisoning, diabetes 
mellitus, artificial-fever therapy, porphyria, diphtheria, and smallpox 
vaccination, and after the administration of tetanus anti -toxin. In a fair 
percentage of cases there is no associated or antecedent illness of any kind. 
A similar divergency of associated diseases was seen among the 17 patients 
observed by the authors. 

If the cases associated with well known peripheral neuropathic entities 
(diphtheria, alcoholism, diabetes mellitus, lead poisoning, porphyria, and 
mechanical compression of nerve roots) are eliminated, most of the remain- 
der can be classified in three ways: (1) cases that are associated with, or 
follow a variety of infectious disease of both viral and bacterial etiology; 
(2) cases that follow parenteral introduction into the body of foreign protein 
(immunization procedures, blood transfusion); and (3) cases in which no 
other antecedent or concomitant clinical phenomena are evident. In the 
search for a common denominator among these three groups, it is conceiv- 
able that an allergic reaction is the underlying pathogenic factor. There are 



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Medical News Letter, Vol. 25, No. 4 



grounds for this theory, though they are admittedly shaky. In the first 
place the outstanding histologic change in autopsied cases is edema of the 
nerve roots. Favour describes it as a "hive of the central nervous system. " 
Finally, recent experience suggests that ACTH and cortisone are of definite 
value in reversing the course of the illness in its early stages, just as they 
do in a number of allergic manifestations. 

At Grasslands Hospital, the disease most frequently confused with 
the Guillain-Barre' syndrome was acute anterior poliomyelitis, particularly 
the bulbospinal variety. 

The prodromes of the two conditions are quite similar and are not 
much help in differential diagnosis except that patients with the Guillain- 
Barre syndrome may complain of being vaguely ill for a number of weeks 
before the onset of the neurologic symptoms. The type of onset is an 
important point. In the Guillain-Barre' syndrome, the onset is usually 
gradual- -fever, severe headache, and meningeal signs are absent though 
they may occur in a mild form; poliomyelitis begins more explosively, 
with severe headache, fever, nausea, vomiting, and stiff neck. Paresthes- 
ias are unusual in poliomyelitis. Sensory changes are an outstanding find- 
ing in infectious polyneuritis whereas they are rare in poliomyelitis; when 
they occur, they are minimal. The paralysis of the Guillain-Barre' syn- 
drome is symmetrical and widespread; it is slower as a rule to develop, 
usually taking two to six weeks. Facial diplegia is present in most cases, 
and the second, third, fourth, and sixth cranial nerves are often involved. 
In poliomyelitis the distribution is often patchy and asymmetrical, particu- 
larly in the cranial nerves; facial diplegia is uncommon, and the second, 
third, fourth, and sixth cranial nerves are infrequently involved; also, the 
paralysis develops more rapidly. The mortality in extensive bulbospinal 
poliomyelitis is considerably higher. Among the patients with extensive 
poliomyelitis, there are usually severe residual paralysis and atrophy-- 
many are respiratory cripples for life. This is not so in infectious poly- 
neuritis, although some degree of residual paresis may occur. The 
cerebrospinal-fluid findings often do not definitely establish the diagnosis; 
during the first week of the disease the patient may show a significant 
pleocytosis, but most patients do not. Pleocytosis is almost always 
present in the fluid of patients with poliomyelitis who become paralyzed. 
However, during the early phases, the spinal-fluid protein in both illnesses 
may be normal or only slightly elevated. During recovery or convalescenc e, 
elevated cell counts are not found in the spinal fluids in either condition. 
The spinal fluid protein in the Guillain-Barre' syndrome soon rises, during 
the progressive phase, to significant levels (it may reach or exceed 2000 rag. 
per 100 cc. ), remaining elevated for months. It is apparently not general- 
ly known that the protein may also rise after the acute stage of poliomye- 
litis, occasionally reaching 300 to 400 mg. per 100 cc. ; however, it usually 
falls to normal within 6 weeks. 



Medical News Letter, Vol. 25, No. 4 



7 



Although there are many differences between the two diseases, on 
occasion the differential diagnosis is very difficult, and the correct diagnosis 
may be made only after weeks of careful observation. {New England J. Med. , 
20 Jan. , 1955; R. E. Crozier, M. D. and A. B. Ainley, M. D. , Grasslands 
Hospital, Valhalla, N. Y. ) 

$ 9fc $ $ Off :Jc 

Probenecid 

Probenecid (Benemid) resulted from a prolonged research effort 
directed toward the discovery of a safe agent that, administered orally, 
would physiologically inhibit the renal tubular secretion of penicillin. Intro- 
duced into clinical medicine in July 1949, the use for which it was intended 
has increased steadily, and new indications for the drug have been disclosed. 
A conservative estimate indicates that 4,000,000 patient days (15,626 patient 
years) of therapy have been administered. Granting that the record of side- 
effects following the use of any therapeutic agent is not static, and that con- 
tinuing use will bring to light an increasing number of side -effects and toxic 
manifestations, an appraisal from time to time seems appropriate. A pre- 
liminary assessment of the toxicity of probenecid was presented in 1951 on 
the basis of 701 patients, and it now possible to report on 2502 patients. 
The information reported in this article was derived from published articles, 
from the reports (unpublished) of many investigators who have communicated 
with the authors, and lastly, from a large series of patients treated by the 
authors. 

Probenecid was developed for the specific purpose of inhibiting the 
renal tubular secretion of penicillin. The penicillemia resulting from any 
given dose of penicillin, regardless of the route of administration or the 
type of penicillin administered, is enhanced 2 to 10 times. Probenecid is 
used in combination with orally administered penicillin, and also in conjunc- 
tion with large doses of parenterally administered penicillin, for the treat- 
ment of so-called "resistant" infections- -particularly subacute bacterial 
endocarditis. 

Originally proposed as an adjuvant to penicillin therapy, it was 
promptly discovered that, predicated upon previous experiences with carina- 
mide, probenecid has a profound uricosuric effect. It seems reasonably 
clear that (1) probenecid inhibits the tubular reabsorption of uric acid in 
gouty patients and lowers elevated serum uric acid levels to normal or 
high normal values; (2) that the uric acid excreted into the urine by gouty 
persons can be tremendously increased; (3) that the turnover rate of the 
miscible pool of uric acid in gouty patients can be favorably influenced, 
and (4) that tophi can be prevented and destructive lesions in the bone 
actually made to heal. Probenecid has been established as an outstanding 
contribution to the management of chronic gout and gouty arthritis. 



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Medical News Letter, Vol. 25, No. 4 



Probenecid administered together with p-aminosalicylic acid (PAS) 
results in enhancement by 15 to 50% of the plasma concentrations of PAS. 
Although this increase in plasma concentrations of PAS is not of the same 
magnitude as that observed with penicillin, it is, nevertheless, reflected 
in terms of increased tuberculostatic activity of human plasma. 

By preference, probenecid is administered orally. The drug is 
rapidly absorbed from the gastrointestinal tract so that measurable con- 
centrations are observed in the plasma within a half-hour after the admin- 
istration of as little as 0.5 gm. 

Although probenecid is used primarily by the oral route, the sodium 
salt can be administered intravenously. There are few indications for 
administering the drug intravenously. During certain renal function inves- 
tigations, it has been found that 2, and even 4, gm. of probenecid could 
be safely administered intravenously. 

A review of 250Z patients indicates that probenecid in a daily dose 
of 2 gm. can be safely administered for periods up to four years. The most 
common manifestation of intolerance is gastrointestinal symptoms, occur- 
ring in 3.1% of patients studied. Typical hypersensitivity reactions have 
been observed in 8 patients and skin rashes have been observed in 34 
patients. The rashes observed have not always been attributed with certainty 
to probenecid, and the likelihood exists that some of them were due to con- 
currently administered penicillin. 

A reasonable presumption is that probenecid, because of its profound 
uricosuric action, may in some cases act as a chemical stress upon the 
biochemical equilibrium of the gouty patient and precipitate an acute gouty 
attack. Tentatively, the statement is made that approximately 10% of 
gouty patients treated will suffer an acute attack of gout shortly after the 
institution of probenecid therapy, however, continued probenecid therapy 
appears to lessen the frequency and severity of acute gouty attacks. Apart 
from the influence on gouty attacks, probenecid-treated patients almost 
universally attest to a sense of well-being. The laying down of new tophi 
can be prevented, and uric acid deposits already established may be 
diminished in size or actually disappear. 

To date, no deaths are attributable to probenecid therapy. There 
is no evidence of aggravation of preexistent renal damage; no hepatic 
toxicity has been observed, and there has been no reported case of suppres- 
sion of the hemopoietic system. A total of 175 side-effects has been noted 
in the group of 2502 patients, representing an over-all percentage of 7.94%. 
Thirty-five of these reported side -effects were related to the urinary tract, 
where the question may be raised whether the manifestations are truly side- 
effects and evidences of toxicity or are, in fact, evidences of the uricosuric 
activity of probenecid. Probenecid is a drug of low toxicity, an outstanding 
contribution to the therapy of chronic gout and gouty arthritis and a valuable 
adjunct to penicillin therapy, orally or parenterally administered. (Arch. 
Int. Med., Jan. , 1955; W. P. Boger, M. D. andS.C. StricIUand, M. D. , 
Norristown, Pa. ) 



Medical News Letter, Vol. 25, No. 4 



9 



Acute Transient Middle Lobe Disease 

The special significance of atelectasis of the middle lobe was first 
pointed out in 1946 by Zdansky and Brock, independently, Zdansky des- 
cribed two cases of middle lobe atelectasis in adults caused by compres- 
sion of the middle lobe bronchus by a calcified lymph node. He noted 
that in children enlargement of a lymph node often causes compression 
of a major bronchus leading to atelectasis of the entire lobe without any 
predilection for any one bronchus and lobe. In adults, on the other hand, 
atelectasis of an entire lobe will occur more frequently in the middle lobe. 
In the other lobes, only the smaller bronchi will be compressed leading 
to segmental atelectasis. 

The first person to coin the term "middle lobe syndrome" was 
E. Graham who, in 1947, reported 12 cases of nontuberculous adults 
having compression of the middle lobe bronchus by enlarged lymph nodes. 
All were characterized clinically by hemoptysis and recurrent episodes of 
pulmonary infection. Atelectasis, fibrosis, and bronchiectasis were the 
pathologic findings. The enlarged, compressing, lymphnodes showed changes 
of a chronic nonspecific lymphadenitis. The necessity of investigating all 
the lobes in each patient was stressed. 

Bronchial occlusion leading to atelectasis of the corresponding lobe 
or segment may occur either by pressure from without (e. g. , by an enlarged 
lymph node or tumor), or by narrowing and obstruction from within (e. g. , 
by edema or fibrous stenosis of the wall or by a plug of mucus occluding the 
lumen). 

A peculiar positioning of a bronchus may make it especially vulnerable 
to any of these causes of occlusion. Such is the case with the right middle 
lobe bronchus. It arises from the main stem bronchus at an acute angle 
and runs in close approximation with the anterior surface of the right lower 
lobe bronchus for a distance of about 0.75 cm. before curving away from 
it in an anterior direction. This makes it more vulnerable to compression 
by the surrounding lymph nodes or to occlusion by a narrowing process 
within it. Moreover, this positioning may hinder adequate drainage from 
the inflamed lobe, leading to greater frequency of recurrence and chronicity 
of pneumonitis in this lobe. This greater frequency of occlusion of the right 
middle lobe bronchus 'as compared with the other major bronchi does not 
occur in children, because in a child all the major bronchi are of a narrow 
caliber and are easily compressible. Hence, lobar atelectasis in children 
occurs without any predilection for any one lobe. Such a situation exists 
also in adults in the case of the smaller secondary or tertiary bronchi; 
hence, segmental atelectasis in adults occurs with equal frequency in any 
lobe. It is only in the case of the major bronchi in the adult that a greater 
frequency of occlusion of the middle lobe bronchus occurs as compared with 
the other major bronchi. 



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Medical News Letter, Vol. 25, No. 4 



The name "middle lobe syndrome" is suggested as an all inclusive 
term for all cases of middle lobe atelectasis regardless of etiology, and 
the name "middle lobe disease" for all cases of atelectasis and pneumon- 
itis which are not caused by active tuberculosis or by neoplasm. While, 
conceivably, some cases might have been caused originally by tuberculous 
lymphadenitis in childhood, the resultant pneumonitis later in life is non- 
specific and not distinguishable from pneumonitis caused by non- tuberculous 
lymph nodes or by mucus plugs and poor drainage. Middle lobe disease can 
thus be defined as characterized by atelectasis and pneumonitis of the mid- 
dle lobe which may be either transient or chronic with or without accom- 
panying bronchiectasis and caused by poor drainage from the middle lobe 
due to the peculiar positioning of the middle lobe bronchus. 

Middle lobe disease should be differentiated from atelectasis caused 
by active tuberculous lymphadenitis or bronchitis, and from that caused 
by bronchogenic carcinoma. The latter should be considered first in every 
case of atelectasis occurring in a middle-aged or elderly individual. How- 
ever, in middle lobe atelectasis, carcinoma is a less likely finding. Brock 
found that, out of 1200 cases of bronchogenic carcinoma, only 8 were in the 
middle lobe. Perhaps this is only a relative infrequency due to the fact 
that atelectasis from various other causes is so much more frequent in 
the middle lobe. 

Once the diagnosis of middle lobe disease has been established, a 
thorough search for involvement in any of the other lobes should be made. 
Bronchography should be done whenever feasible to rule out bronchiectasis 
in any other lobe, especially in cases of chronic pneumonitis considered 
for surgery. Bronchoscopy should be done in every case. (Dis. Chest, 
Jan. , 1955; E. Rosenman, M. D. , LosAngeles, Calif. ) 

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Treatment of Cardiovascular Disease 
with Anticoagulants 

The use of anticoagulants is restricted currently because adequate 
prothrombin time determinations are absolutely essential to their use. 
Such determinations do not require elaborate laboratory equipment, but 
they do require a very carefully trained, conscientious technician. 

These drugs are used increasingly in exacerbations of coronary 
insufficiency. This occurs (1) when angina develops suddenly and rather 
severely; (2) where a pre-existing stable angina increases suddenly in 
severity or frequency; (3) when angina of effort suddenly becomes com- 
plicated by nocturnal angina, or status anginosus occurring with little 
or no effort; (4) when the progress of coronary disease indicates an acute 
exacerbation. It is well known that many- -probably most-- cases of 



Medical News Letter, Vol. 25, No. 4 



11 



myocardial infarction are preceded for a few days or weeks by so-called 
premonitory symptoms. These symptoms are an exacerbation of the symp- 
toms of coronary disease without an outright infarction. 

Indications for using these drugs in rheumatic heart disease, with 
auricular fibrillation and emboli, are clear. The author doubts that they 
are indicated under these circumstances unless there is actual evidence 
that thrombo-embolism has occurred, although some physicians contend 
they are desirable whenever failure and auricular fibrillation are present, 
particularly in older patients. 

Venous thrombosis of various kinds - -thrombophlebitis , phlebothrom- 
bosis, migrating thrombophlebitis --is a clear-cut indication for use, as are 
arterial embolism or thrombosis and pulmonary embolism from any cause 
whatever. 

The first and most important contraindication to anticoagulant therapy, 
the one that must be emphasized repeatedly, is lack of a laboratory to pro- 
vide reliable prothrombin time determinations. If reliable measuring equip- 
ment is not available, Dicumarol or similar anticoagulants should not be used. 

The second contraindication for use is an erratic or uncooperative 
patient. Some patients vacillate; one day they feel they don't need the pills, 
and another day they take more than the prescribed amount because of feel- 
ing unwell. With such a patient, the anticoagulants are so dangerous they 
are not useful. Another type of patient is not erratic in his cooperation 
but in his response to the drug, for reasons which are completely unknown. 
Often it is impossible to know whether a patient is unduly erratic in his 
response because of metabolic, biochemical and physiologic reasons, or 
whether he is erratic in using the drug. 

Dicumarol is a potent, useful adjunct in the treatment of thrombo- 
embolic disease. The general fields of its usefulness are well defined. 
More work is necessary to establish its role in mild diseases and in pre- 
venting emboli. The therapy is demanding of the physician from a tech- 
nical standpoint and a laboratory which provides reliable prothrombin 
time determinations is essential. Dicumarol can be used only with intel- 
ligent cooperative patients. (Postgrad, Med., Jan. , 1955; W. R. Adams, 
University of Chicago School of Medicine, Chicago, 111. ) 

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Ultraviolet Microscopy of Renal Vascular Diseases 



In recent years, pathologists have applied many new tools to the 
analysis of tissue changes in kidney disease. Histochemistry, micro- 
spectrography, phase contrast microscopy, ultraviolet microscopy, and 
electron microscopy have yielded new evidence to support or refute tra- 
ditional ideas of the morphologic bases of various kidney lesions. Another 



12 



Medical News Letter, Vol. 25, No. 4 



new technic, which permits color photomicrography in ultraviolet light, 
has recently become available. The Polaroid color-translating ultra- 
violet microscope allows the operator to choose any three wave lengths 
in the range of 2330 to 4000 Angstrom units, and to obtain accurately 
focused photomicrographs on 35 mm. film of tissues and other material, 
with each of the three wave lengths translated into a different color: blue , 
green, and red. In the machine are a rapid film processor and a projec- 
tor which superimposes the three images into a single colored picture. 

To investigate whether stromal tissues had any peculiarities of 
ultraviolet absorption, an inquiry into the properties of normal and abnor- 
mal human and animal kidney tissues was undertaken. Kidney was chosen 
because it proved easy to identify its histologic components with the optical 
telescope and green-black contrasting appearances of unstained tissue used 
in the Polaroid instrument which has green light for preliminary visual 
survey of the slide. 

A surprising variation in the ultraviolet absorptions of glomeruli 
from different human kidney diseases was observed and is being reported 
elsewhere. The absorption behavior was uniform between different slides, 
different kidneys, and different persons with the same pathologic condition. 
In the case of persons with diabetes mellitus, the changes of glomerular 
stroma were considered distinctive enough to be diagnosed by ultraviolet 
photomicrography in the presence or absence of identifiable pathologic 
alterations by ordinary pathologic criteria. The ultraviolet absorptive pro- 
perties of arteries and arterioles in the same kidneys are considered in 
this article. 

Studies of tissue pathology using ultraviolet light over a considerable 
range of wave lengths are new. Many findings have been and probably will 
be unexpected, such as the distinctive differences observed in glomerular 
stromal absorptions in various clinically and pathologically identifiable 
glomerular diseases. Aside from concluding from the study of different 
blocks of kidney tissues from various patients that the observations were 
not due to localized peculiarities of certain areas of tissue, and were uni- 
form for individual disease entities, no complete explanation was available 
to explain the ultraviolet absorptive behavior of diseased glomeruli. Bio- 
chemical observations of the ultraviolet absorption spectra of collagen, 
during successive purification procedures which removed ground substances, 
have shown similar changes in the same wavelength range as investigated 
in the present study. This suggests that mixtures of partly denatured glo- 
merular stromal proteins surrounded by abnormal amounts of normal or 
abnormal ground substances could be responsible for the observations. 

Arteries and arterioles of diseased kidneys studied have proved less 
labile than glomeruli in demonstrating abnormal ultraviolet absorptions. 
In fact, short of necrosis of their walls, no significant alterations from 
normal ultraviolet properties were observed in various important kidney 



Medical News Letter, Vol, 25, No. 4 



13 



diseases. Despite definite morphologic changes in arterial walls in these 
conditions, ultraviolet absorptions were considered within normal limits. 

Possible explanations suggested for the negative findings are (1) that 
the material was chosen particularly to study glomeruli and did not illus- 
trate the most outspoken arterial and arteriolar lesions. However, there 
were striking vascular changes, at least in the diabetic amyloidosis, and 
periarteritis nodosa material. (2) Despite histologic changes, the pre- 
ponderance of normal smooth muscle and collagen still unaltered in most 
of the blood vessel walls perhaps obscured abnormalities in ultraviolet 
absorption. In glomeruli, a significantly greater proportion of stroma 
was likely damaged, with resulting visibly altered ultraviolet properties. 

The positive findings of greatly increased ultraviolet absorption, up 
to eight times normal, in the vascular necroses of malignant arteriolar 
nephrosclerosis and periarteritis nodosa were unexpected, because no such 
increased density is found with visible light. The normal ultraviolet absorp- 
tions of adjacent kidney tissues testified that this change was not attributable 
to increased thickness of sections or other technical factors. Apparently, 
protein denaturation and coagulation with precipitation of colloids may be 
partly responsible. Whether some inorganic materials like calcium or 
iron are also attached to protein and add to the ultraviolet opacity remains 
to be determined. 

Further studies with ultraviolet photomicrography of renal vascular 
diseases would appear promising. It would be of interest to investigate 
the effects of enzymes, hydrolyzing agents, and salts upon the ultraviolet 
absorptive properties of vessel walls. Because the slides are examined 
unstained, later histochemical studies of the identical sections are feasible. 
(Circulation, Jan. , 1955; S. C. Sommers, M. D. , R. Crozier, M. A. , and 
S. Warren, M. D. , Cancer Research Institute, New England Deaconess 
Hospital, Boston, Mass. ) 

An Improved Method for Skin Graft 
Coverage of Extensive B urns 

The ultimate objective in the treatment of burns is the earliest 
possible healing with the minimum of residual deformity. This article 
presents an improved method of skin grafting extensive third degree burns. 

The authors used the Reese dermatome with the Dermatape backing 
as the mechanism for obtaining the skin grafts. By this means the normal 
skin tension is maintained, insuring maximal use of all donor skin. The 
use of the Dermatape backing, which is firmly adherent to the donor skin, 
facilitates the handling of the stamp grafts. The Dermatape backing not 
only prevents the grafts from rolling or curling, but maintains the split 



14 



Medical News Letter, Vol. 25, No. 4 



skin flat with normal skin tension, thus expediting the procedure. It is 
believed that the method of cutting the stamp, the size and pattern of the 
stamps, are important considerations in the maximal utilization of avail- 
able skin. 

Each Reese Dermatape furnishes approximately thirty-two square 
inches of split skin, an area four by eight inches. The Dermatape, to which 
the skin graft is adherent, is cut into strips one inch wide, thus creating 
eight strips in a complete drum of split skin. Each strip is then cut into 
squares one inch on a side, which in turn is cut in half diagonally producing 
a triangular stamp. Pinking scissors are used in cutting these stamps. 
This type of scissor is used in order to create a regularly serrated edge 
on the edge of the individual triangular stamp; this increases the peripheral 
length over 25%. The effect of these serrations not only increases the peri- 
pheral length, but eliminates to a large degree the straight line contracted 
scars which often occur between the grafts. The serrated edge offers the 
effect of a multiple Z -plasty. When these stamps are placed on the recipient 
site about one -quarter of an inch apart, the surface coverage is increased 
100%. In a 4 by 8 inch sheet graft, the total peripheral edge is 24 inches, 
however , utilizing the stamps in the fashion described above increases the 
peripheral edge to 256 inches. 

When the grafts are placed at one-quarter inch intervals, the final 
result is smooth and uniform with a minimum of scarring. If the donor 
site is not adequate for coverage of the burn area, the grafts should not 
be scattered widely, but should be placed at the standard interval for com- 
plete optimum healing. After the donor site has healed, it may be reused 
if necessary to complete the grafting procedure. The authors believe that 
the use of a thin graft is indicated to assure early healing of the donor site 
and subsequent reuse of the donor site. According to their experience in 
small children, the average thickness of skin used is .008 inches and, in 
adults, it is .012 inches. However , there can be no hard and fast rule con- 
cerning the determination of the optimum thickness of the graft because 
it varies with age, sex, and race of the patient. 

Another advantage of using this procedure is that the application of 
the stamp graft can be done quickly without prolonged anesthesia, a con- 
sideration of great importance in the individual whose general condition 
is poor. The policy of the writers is to limit the total anesthetic time in 
patients with severe burns to a maximum of one hour, which is usually 
enough time to cut and apply four drums of split skin. The anticipated 
"take" of "stamp grafts" approaches 100%, whereas the "take" in a "sheet 
graft" in a similar area may be variable and often disappointing. 

The application of the grafts to the recipient area is rapid and simple 
because no sutures are required to fix them in position. After they are 
placed on the granulations, the entire area is covered with a fine layer of 
wrung -out vaseline gauze. Then several thicknesses of saline - soaked 



Medical News Letter, Vol. 25, No. 4 



15 



gauze pads are molded over the surface. These dressings are then fixed 
into position by a circular dressing of kerlix gauze or pressure roll for 
purposes of gentle compression and increased bulk. The outer dressing 
consists of an elastic type bandage to stabilize the underlying dressings. 

In spite of the numerous procedures which have been described for 
grafting burns, the authors believe that the present day problem is more 
pressing than the treatment advocated a few years ago. Primarily, the 
present problem is different in that the survival rate of major burns is 
higher, consequently, there are many situations requiring skin grafts 
of the burned areas with a relative scarcity of donor site skin. It is for 
this reason that they believe the technique described is worth considera- 
tion to obtain maximum utilization of a minimal donor site. {J. Indiana 
M. A. , Jan. ,1955; J. M. Tondra, M. D. , H. M. Trusler, M. D. , and 
T. B. Bauer, M. D. , Indianapolis, Ind. ) 

Benign Ulcers of the Greater C urvature 
of the Stomach 

Benign ulceration along the greater curvature of the pars media of 
the stomach is uncommon. Levin and associates collected from the litera- 
ture 20 cases of histologically proven benign ulcers of the greater curvature 
and added one case of their own in 1949. Griffin found 32 cases of proven 
benign ulceration along the greater curvature in the literature to 1954, 
and added three cases, two of which were in the antrum and one in the pars 
media of the stomach. Danstrom, Lowry, and Colvert recently reported 
five cases, all verified by microscopic study. This makes a total of 40 
cases of benign, histologically proven gastric ulcer along the greater 
curvature, exclusive of autopsy studies, which have been reported. 

Two patients with benign ulceration along the greater curvature of 
the pars media of the stomach were recently observed by the authors. 
Because of the uncommon occurrence of such lesions, and because of the 
problem as to whether treatment of these lesions should be medical or 
surgical, the cases were reported. 

Each of these two patients had benign ulceration along the greater 
curvature of the pars media of the stomach, and each had multiple gastric 
ulcers, one having two and the other four. In each case, the multiplicity 
of the ulcers was discovered only at operation and their benign nature 
subsequently was established by histologic study. Both patients had been 
advised to undergo surgery because of indications of possible malignancy 
on roentgenographic and other clinical examinations. Gastroscopic exam- 
inations were not performed because the authors believed that, on the basis 
of other evidence, surgery was warranted regardless of possible gastro- 
scopic findings. 



i 



16 



Medical News Letter, Vol. 25, No. 4 



The authors have previously shown that malignant transformation 
of benign gastric ulcers does occur but that such transformation is rare. 
The problem of gastric ulcers is not whether a specific ulcer will become 
malignant, but whether it is malignant now --that is, the differential diag- 
nosis of benign and malignant ulcers. For typical benign ulcers along the 
lesser curvature, they believe that a trial of adequate medical treatment 
with a careful follow-up is indicated. 

Many writers advocate surgical treatment for every lesion of the 
greater curvature of the stomach because of the high incidence of malig- 
nancy. Bockus stated that a benign ulcer niche rarely projects from that 
region in the usual roentgenograms, and he advocated considering and 
treating all such lesions as malignant. Kennedy and Beck stated that, 
only after histologic examination of the resected lesion is it possible to 
determine diagnostic ally that ulceration of the greater curvature of the 
stomach is benign. 

The possibility of gastric malignancy of the greater curvature cannot 
be excluded or confirmed by roentgenographic examination, by gastroscopic 
examination, or even by inspection of the stomach at operation. Several 
cases were observed in which frozen sections at the time of operation 
showed no evidence of neoplasm, but permanent sections later disclosed 
the carcinoma. Consequently, if any findings from clinical, roentgeno- 
graphic, or gastroscopic examination are suggestive of neoplasm, surgical 
treatment should be advised. The high incidence of carcinoma along the 
greater curvature necessitates that all such lesions be regarded and treated 
as malignant. (Cleveland Clin. Quart., Jan., 1955; C. H. Brown, M. D. and 
A. D. Intriere, M. D. , Cleveland Clinic , Cleveland, O. ) 

i|E !{C SjS 5(S ifC $ 

Tracheo-Esophageal Fistula Due to Blast Injury 

Fistulous communications between the trachea and esophagus are 
not common lesions, but neither are they rare. These fistulae are of two 
principal types: those of congenital origin, and those which are acquired. 
The latter are further subdivided into the malignant and the non-malignant 
varieties. Malignancy has been established as the most common cause of 
acquired fistulae. 

In a consideration of lesions of this type not due to malignancy, 
Coleman and Bunch reviewed 75 cases and found that infection was their 
most common etiologic factor. In the majority of recorded cases, the 
trauma has usually been some form of direct violence, including chemical 
injuries, perforation by ingested foreign bodies, penetrating wounds, or 
the result of a false passage created during diagnostic or therapeutic 
endoscopy. 



Medical News Letter, Vol. 25, No. 4 



17 



In a final extremely small group of patients, an acquired benign 
tracheo-esophageal fistula has resulted from indirect violence or non- 
penetrating trauma. Fistulae arising on this basis are exceptionally rare 
and no case has hitherto been recorded in the literature in which such a 
lesion was caused by a blast injury. Because of its unique etiology, a case 
is reported in this article. 

A careful review of the literature reveals this to be the eighth record- 
ed case of tracheo-esophageal fistula due to non-penetrating trauma. It is 
of interest that all of the patients have been young men, ranging in age 
from 19 to 31 years. Five of the eight cases were caused by motor vehicle 
accidents, and three of these five reports state specifically that the patient 
was thrown against the steering wheel. No details were given in the other 
two cases. 

From 10 to 19 weeks elapsed between the time of injury and surgical 
repair, with the exception of one patient who was operated upon four and 
one-half weeks after the injury. The symptoms are usually severe, though 
rarely they may be minimal, and a patient has been reported in whom the 
fistula was present for 5 years before medical aid was sought. 

Almost immediately after swallowing liquids, the patient complains 
of a strangling sensation and develops a severe paroxysm of coughing 
productive of the ingested fluid. Early after the injury, eating of solid 
foods will usually produce the same reaction. However, if the fistula is 
not too large, the patient can swallow solids by strategically leaning in a 
position that will allow the solid food to pass by the fistulous tract. This 
usually does not become possible until several days or even weeks after 
the injury. The clinical diagnosis should be suspected from the history 
and symptom complex and it can be established readily by outlining the 
fistula with lipiodol which is best instilled into the proximal esophagus 
through a catheter passed just distal to the pyriform sinus. By this means 
one may be sure that lipiodol which appears in the tracheo-bronchial tree 
has not been aspirated. The fistula also may be visualized at bronchoscopy 
and esophagoscopy, although mucosal folds may in part obscure the fistula, 
causing the endoscopist to underestimate its extent. Such a situation pre- 
vailed in the case reported in this article. 

It has been stated that, occasionally, a tracheo-esophageal fistula 
will heal with conservative treatment. If the opening is a few millimeters 
in diameter, as may result from perforation during endoscopy, intra- 
luminal cauterization with silver nitrate or sodium hydroxide may effect 
a cure. If the fistula is larger, the tract usually becomes lined with epi- 
thelium. Once the fistula is epithelialized, spontaneous closure will not 
occur and if the opening is more than a few millimeters wide, cauteriza- 
tion will almost certainly be ineffective. 

A program of "esophageal rest" has been recommended. If the fistula 
is small, a Levin tube should be used, while if it is large, either a gastros- 
tomy or jejunostomy has been advocated; the former, if the tracheo-esophageal 



18 



Medical News Letter, Vol. 25, No. 4 



fistula is above the level of the aortic arch, the latter if it is below this 
level. Direct operative repair .is usually the procedure of choice. (Ann. 
Surg. , Jan. , 1955; H. Volk, LT MC USNR; C.F. Storey, CAPT MC USN, 
and A. G. Marrangoni, LT MC USNR, U. S. N. H. , Portsmouth, Va. ) 

Aneurysmal Bone Cysts 

In a comprehensive review of the records of more than 2000 primary 
bone lesions encountered at operation at the Mayo Clinic in the period 1905- 
1952, 26 aneurysmal bone cysts were found. 

The specific term "aneurysmal bone cyst" did not appear in the litera- 
ture until 1942, when Jaffe and Lichtenstein stated for the first time that it 
was probably a distinct entity and described the findings in two cases. In 
many articles prior to this, especially those concerning giant-cell tumors 
and their "variants, " more or less complete descriptions of the lesion are 
encountered under a variety of names. Ewing, in 1940, employed the term 
"aneurysmal giant-cell tumor" for the condition, which he considered to be 
a benign variant of a giant-cell tumor taking the gross form. of a bone aneu- 
rysm. 

Although the term "aneurysmal bone cyst" was coined in 1942, the 
literature of the succeeding eight years contains no single comprehensive 
article on this subject. 

The age distribution of the 26 patients in this series was: ages 5 to 9 

years, five cases; 10 to 14, six cases; 15 to 19, seven cases; 20 to 24, four 

cases; 25 to 29i two cases; 35 to 39, two cases. The average age was 17.2 

years, with a range from 5 to 37. Eighteen patients were less than 20 years 

old. This age distribution is similar to that of the previously reported cases. 

Females predominated in a ratio of 16 to 10. 

t 

Aneurysmal bone cysts have been reported in the vertebral column, 
long bones of the extremities, clavicle, ribs, occipital bone, metacarpals, 
carpals, metatarsals, tarsals, sacrum, innominate bone, and scapula. 
As yet they have not been reported in the remaining bones of the calvarium, 
the mandible, or the facial bones. 

The most frequent clinical complaints in the series were pain, swel- 
ling, limitation of motion, and tenderness. Twenty-three patients com - 
plained of pain, 23 of swelling, 1 1 of limitation of motion, and 18 of tender- 
ness. The pain and swelling were frequently associated. Usually the pain 
was not severe but was increased in intensity by exercise. The swelling 
developed slowly but was progressive. Limitation of motion generally 
resulted from encroachment on a joint. 

The duration of symptoms, as reported by others and confirmed by 
the authors' experience, was relatively short. It varied in this series of 
cases from 3 weeks to 3 years with an average of approximately 6 months; 



Medical News Letter, Vol. 25, No. 4 



19 



A history of local trauma was reported in cases discussed elsewhere 
as well as in 12 cases of the series observed by the authors. Trauma had 
occurred usually from a few days to one month before the onset of symptoms. 
In all probability, the injury merely called attention to the lesion by causing 
a local exacerbation of symptoms. 

The aneurysmal bone cyst has a rather typical roentgenologic appear- 
ance in most instances. In about 16 cases in the series a diagnosis could 
have been made preoperatively with reasonable certainty. The pertinent 
findings include a circumscribed area of rarefaction, a soap-bubble or 
honeycombed appearance of the interior of the lesion, eccentric bulging 
of the cortex (which is usually disrupted), a peripheral, delimiting, thin 
shell of periosteal new bone, and, in young patients, a location in the dia- 
physis adjacent to the epiphyseal cartilage. 

The lesions which may bear a certain resemblance to aneurysmal 
bone cysts, from the standpoint of the roentgenologist and the pathologist, 
include benign giant-cell tumor, hemangioma, fibrous dysplasia, and simple 
bone cyst. 

Aneurysmal bone cyst is a distinct benign pathologic entity. In approx- 
imately two-thirds of the cases it exhibits a characteristic roentgenographic 
picture. Curettage is the treatment of choice, and at the time of the opera- 
tion, the gross features of the cyst should make its recognition possible. 
The macroscopic and microscopic features establish the correct diagnosis. 
(Radiology, Jan. , 1955; D. C. Dahlin, M. D. , B. E. Besse, Jr. , M, D. , 
D. G. Pugh, M. D, and R. K. Ghormley, M. D. , Mayo Clinic and Mayo 
Foundation, Rochester, Minn. ) 

$ $ S(c $ * # 

Aviation Medical Acceleration Laboratory 
Johnsville, Pennsylvania 

With the advent of high-altitude, high- velocity, high-performance 
flying in military aircraft, it has become necessary to intensively engage 
in research in aviation medicine to determine the physiological limits im- 
posed on the body by such aircraft. 

It is generally assumed today that the engineers have made greater 
progress in the design of aircraft for high performance than have medical 
personnel in their attempts to evaluate the physiological factors which enable 
men to fly higher and faster. The three main objectives in studies of the 
human factors in high- altitude, high velocity, high-performance flying are: 
(a) to expand the human frontiers of aviation; (b) to set the physiological 
limits of the human body under stress, and hence the limits of altitude, 
velocity, and acceleration beyond which certain aspects of flying and cer- 
tain maneuvers cannot be engaged in without serious damage to the personnel 



20 



Medical News Letter, Vol. 25, No. 4 



involved; and (c) to indicate for the engineers certain aspects of aircraft 
design in order to increase the chances of survival, or decrease the fatigue 
of flying, or decrease the hazards of anoxia or cold, or increase the prob- 
ability of escape from aircraft, or increase the chance of accomplishing 
a successful offensive or defensive maneuver. 

The Human Centrifuge at the Aviation Medical Acceleration Labora- 
tory, Johns ville, Pennsylvania, was specifically designed and is particu- 
larly suited for research in aviation medicine having the above objectives, 
and simulation of high -altitude, high-velocity, high-performance aircraft 
can be made with this device under controlled conditions, and with appro- 
priate instrumentation and controlled measurements of man's reactions 
and performance. Some of the important contributions related to the above 
objectives are: 

1. Studies of the pilot's ability to actuate controls in high performance 
aircraft, or in event of emergencies such as are encountered in an uncon- 
trolled aircraft. 

2. Tolerance to acceleration stress as is encountered in high per- 
formance aircraft in flight. 

3. In event of bail-out, studies on deceleration, hitting the air 
stream, the ram pressure of air, the opening shock of the parachute, and 
anoxia and frostbite. 

4. Tolerance to acceleration such as may be encountered in launch- 
ing of high performance aircraft from carrier deck. 

5. Recovery of aircraft with high landing speeds in the limited 
deck space. 

6. Protection of pilot, deck crew, and bridge personnel from high 
intensity noise and heat from superpowered jet engines. 

Research in aviation medicine today requires a coordination between 
physiological and engineering practices with end results in the form of 
equipment or methods often being a compromise between physiology and 
engineering. It is the recognition of the medico-mechanical or bio- 
engineering aspects of problems in aviation medicine that has brought 
about successful accomplishments in this area. 

l{£ jjC ?{< 5p jfc 

Change of Address 

Please forward requests for change of address for the News Letter to: 
Commanding Officer, U.S. Naval Medical School, National Naval Medical 
Center, Bethesda 14, Md. , giving full name, rank, corps, and old and new 
addresses. 



# $ s}: % 



Medical News Letter, Vol. 25, No. 4 



21 



" A Letter " 

The following letter is published with the approval of the Surgeon 
General and the author. 

"On October 30, 1954, I was released from active duty with 
the Medical Corps of the U.S. Navy. I would like to express my 
thanks to your department for a relatively enjoyable and most 
profitable two years. 

I do not in any manner or form feel that my two years were 
"wasted". My training in surgery was utilized to its fullest where 
the situation would allow. I gained valuable experience in the field 
of trauma while with the First Marine Division in Korea, which I 
could never have equalled in any residency in the United States. 
More important, it was one time in life that I honestly felt that 
I was doing as much for my fellow man as was possible. 

I met some outstanding doctors in the Regular Corps. By 
and large most of them did everything they could to make life 
pleasant and interesting. I flew more than 16,000 miles and visited 
Honolulu, Wake, Guam, Okinawa, and Japan, not to mention Korea 
which could hardly be classified as an exotic land. This travel 
broadened my education and helps me to understand this world 
a little better. I must admit that my one regret was, that I did 
not get on board a ship during my tour. The closest being the 
Coronado Ferry while stationed in San Diego. 

I fully intend to stay in the Reserve because I sincerely feel 
it is an honor and a privilege to be able to serve our country when 
our service is needed. I'm prejudiced, and I feel the best place 
to serve is with the Navy. 

Once again my sincerest thanks to the Medical Corps of the 
Navy for a most pleasant and educational tour of duty. " 

****** 
"Honors" 

Captain Waltman Walters, MC USNR, Professor of Surgery, Uni- 
versity of Minnesota Graduate School, Rochester, and Chief Editor A.M. A. 
Archives of Surgery, and the Lewis -Walter s "Practice of Surgery, " has 
been named as recipient of the 1954 honor award of the Mississippi Valley 
Medical Society. The honor award consists of a plaque and a gold medal 
and is given from time to time to nonmembers of the Society "who have 
made distinguished contributions to clinical medicine. " (Medical News, 
J. A. M. A. , 15 Jan. , 1955. ) 

sjc sjc jjc sjc s^c sQc 



22 



Medical News Letter, Vol. 25, No. 4 



Retirements 

Subsequent to the easing of restrictions on voluntary retirement 
in .1954, 14 Regular Navy medical officers with service in excess of 20 
years, but with less than 30 years, have requested retirement. Eleven 
of the requests have received Presidential approval and the officers con- 
cerned have been, or will be, transferred to the Retired List and released 
to inactive duty. The medical officers whose requests have been approved 
are as follows : 

Captain Melvin D. Abbott 
Captain Martin V. Brown 
Captain Elmer L. Caveny 
Captain Adrian J. Delaney 
Captain Frederic W. Farrar 
Captain Fred Harbert 

Captain Freeman C. Harris , 
Captain Thomas W. Mc Daniel 
Captain Paul Peterson 
Captain Gerald W. Smith 
Captain John J. Wells 

Training Course in Field Medicine 

A course in Field Medicine is scheduled to be conducted at U. S. 
Marine Corps Barracks, Camp Pendleton, California, on 15 March 1955, 
for the benefit of Naval Reserve male medical personnel residing in the 
11th, 12th, and 13th Naval Districts. 

The course is of two weeks' duration and is designed to provide 
specialized training in field medicine including practical instruction in 
medical material logistics, preventive medicine in the field, professional 
treatment of emergencies, and medical organization with Fleet Marine 
Units. In addition, the trainee will receive practical instruction of a 
military nature including the maintenance and use of small arms, items 
of individual equipment, practical march and bivouac. 

Eligible personnel who desire to attend this course in a pay status 
should submit their request to the Commandant of their home naval district 
at the earliest practicable date. Bachelor Officers' Quarters will be avail- 
able. Working uniform is required. 

Attention is invited to the fact that attendance at this course will not, 
in any way, increase the reservist's vulnerability for orders to extended 
active duty. (ResDiv, BuMed) 

& $ % $ % 4 



Medical News Letter, Vol. 25, No. 4 



23 



From the Note Book 



1. Captain E, L. Caveny, MC USN, who was placed on the Retired List 
of officers of the Navy on January 1, 1955, after more than 24 years of 
service, has assumed the post of Chairman of the Department of Psychiatry 
and Neurology and Professor of Psychiatry at the University of Alabama. 

At the time of his retirement, Captain Caveny headed the Neuropsychiatry 
Branch of the Navy's Bureau of Medicine and Surgery. (TIO, BuMed) 

2. Rear Admiral R. O. Wells, DC USNR, Brooklyn, N. Y. ;Dr. O. M. Dresen, 
Dean, School of Dentistry. Marquette University, Milwaukee, Wis. , and 
Dr. W.C. Fleming, Dean, College of Dentistry, University of California, 
San Francisco, Calif. , have been appointed as Honorary Dental Consultants 
to the Chief of the Dental Division of the Bureau of Medicine and Surgery 
by the Assistant Secretary of the Navy (Personnel and Reserve Forces). 
(TIO, BuMed) 

3. Current planning indicates that there will be fewer dental officers 
required in fiscal year 1956. It appears that those senior dental students 
already participating in the ensign dental program will meet the Navy's 
dental officer requirements. Recruiting Service Note No. 6-55 of Jan., 4, 
1955, temporarily suspends recruiting of civilian applicants for appoint- 
ments and active duty in the Dental Corps of the Naval Reserve. Procure- 
ment of women and priority IV dentists with more than 17 months of prior 
military service, as defined in Section 4(i) of the Universal Military Train- 
ing and Service Act, for inactive duty, will continue. With 350 Ensigns 1995, 
Dental, already commissioned in the 1955 graduating class, procurement of 
senior dental students is suspended, except for those who by law are not 
required to serve on active duty because of prior military service. The 
ensign program is stilllopen for students in the junior, sophomore, and 
freshmen classes. (TIO, BuMed) 

4. The "U.S. Naval Dental Corps Casualty Treatment Training Program" 
exhibit was displayed at the Chicago Dental Society Meeting, Chicago, 
111. , Feb. , 6-9, 1955. CDR J. V. Niiranen, DC USN, monitored the 
exhibit. (TIO, BuMed) 

5. Captain L. B. Shone, MC USN, Head of the Industrial Health Branch, 
Preventive Medicine Division, represented the Bureau of Medicine and 
Surgery at the Mclntyr e -Saranac Conference on Occupational Chest Dis- 
eases held under the joint sponsorship of the Mclntyre Research Founda- 
tion of Toronto, Canada, and the Saranac Laboratory of Saranac Lake, N. Y., 
Feb., 1955. (TIO, BuMed) 



24 



Medical News Letter, Vol. 25, No. 4 



6. CDR J. R. Seal, MC USN, Head of the Communicable Disease and 
Environmental Sanitation Branches, Preventive Medicine Section, dis- 
cussed the "Prevention and Control of Streptococcal Disease in Recruit 
Training Stations" before a meeting of the Rheumatism Society of the 
District of Columbia, held in the Library of the Medical Society Building, 
Washington, D. C. , Jan. , 20, 1955. (TIO, BuMed) 

7. Lauriston S. Taylor of the National Bureau of Standards has been pre- 
sented the Gold Medal of the Radiological Society of North America for 
his leadership in the field of radiation protection on a national and inter- 
national scale. This society, which is made up of scientists and prac- 
titioners in the field of radiology, gives the Gold Medal annually for 
outstanding accomplishments in the field of radiology. (NBS, TRP 8321) 

8. The name of the official journal of the Association of Military Surgeons 
has been changed from the "Military Surgeon" to "Military Medicine. " 
(Mil. Med. , Jan. , 1955. Editorial) 

9. Cylindromata occurring on the head in such numbers as to cover the 
scalp more or less completely are commonly called turban tumors. Individ- 
ual tumors vary in size from a few mm. to 4 or 5 cm. in diameter and may 
be grouped like bunches of tomatoes. The tumors grow slowly and are 
benign. (Brit. J. Dermat. , Dec. , 1954; CD. Evans) 

10. It is as wrong for a surgeon to undertake a difficult operation for which 
he has not been trained as it is for a man to run a sports car through a foot- 
ball crowd before he has passed his driving test. It is as criminal for a 
surgeon to practice and publish a new operation without complete study as 

it is for a manufacturer to put a dangerous drug on the market without 
previous laboratory tests. (B.M. A. , 18 Dec. , 1954; Sir Heneage Ogilvie) 

11. The author describes a method, which he considers original, of recon- 
struction of a partially or totally destroyed thumb and its metacarpal bone. 
He presents the rationale of his technic for "pollicization" of the fourth 
finger. (J. Internat. Coll. Surgeons, Dec. , 1954; R. Letac, M. D. , Dakar, 
B. W. A. ) 

12. This article describes several tissue-culture methods for studying 
bone-cell growth and differentiation, and presents an application of these 
techniques in determining the viability of cells after storage by freezing. 
(J. Bone & Joint Surg. , Dec. , 1954; R. D. Ray, M. D. , R. Mosiman, M. D. , 
J. Schmidt, M. S. ) 

13. The important assets in the successful treatment of meningitis are sense 
and simplicity in the mode of management. (Ann. Int. Med. , Dec. , 1954; 

A. L Hoyne, M. D. ) 



Medical News Letter, Vol. 25, No. 4 



25 



14. The authors have attempted to investigate experimentally the major 
ingredients of the cigarette as possible carcinogenic agents of lung tumors. 
The smoke of cigarette paper has been studied and the results are reported. 
The results indicate that cigarette paper has little or no effect on the genera- 
tion of lung tumors in albino mice. (Science, Dec. , 1954; J. M. Essenberg) 

15. The conservative nonoperative treatment of lumbar disk lesions is 
discussed in Postgrad. Med., Dec. , 1954; J. W. White, M. D. 

16. The motor car has killed more people in 50 years than all our wars 
combined. When the motorcar stops suddenly, the occupants continue in 
motion and are killed by blows from the car interior or by outside objects. 
The solution is simply to keep the occupants in their seats. The universal 
use of the seat belt will save thousands now doomed to die. (Surgery, Dec. , 
1954; H. E. Campbell, M. D. ) 

Board Certifications 



American Board of Anesthesiology 

LT Warren H. Ash (MC) USNR (Inactive) 

American Board of Internal Medicine 

LCDR Hyman Alexander (MC) USNR (Inactive) 
LT Robert H. Areson (MC) USNR (Inactive) 
LT Joseph A. Bailey (MC) USNR (Inactive) 
LT JG Ivan L. Bennett, Jr. (MC) USNR (Inactive) 
LT Frank P. Brooks (MC) USNR (Inactive) 
LT Samuel W. Budd, Jr. (MC) USNR (Inactive) 
LTJC Edmund J. Callahan III (MC) USNR (Inactive) 
LTJG Robert S. Gordon (MC) USNR (Inactive) 
LTJG Marshall J. Hanley (MC) USNR (Inactive) 
LT Eugene A. Hildreth, Jr. (MC) USNR (Inactive) 
LTJG James G. Hilton (MC) USNR (Inactive) 
CDR Elmer E. Hinton (MC) USNR (Inactive) 
LT Charles F. Kane (MC) USNR (Inactive) 
LTJG Morris Klatzko (MC) USNR (Inactive) 
LT Henry J. Koch, Jr. (MC) USNR (Inactive) 
LT Howard J. Lockward (MC) USNR (Inactive) 
LT Edwin D. Longaker (MC) USNR (Inactive) 
LTJG Edward H. McGehee (MC) USNR (Inactive) 
LTJG Robert R. Montgomery (MC) USNR (Inactive) 
LT William J. Noble (MC) USNR (Inactive) 



26 Medical News Letter, Vol. 25, No. 4 



American Board of Internal Medicine (continued) 
LT Herbert M. Perr (MC) USNR (Inactive) 
LiTJG Luigi A. Principato (MC) USNR (Inactive) 
LT William A. Schaeffer (MC) USNR (Inactive) 
LT William B. Scharfman (MC) USNR (Inactive) 
CDR Kenneth E. Smith (MC) USNR (Inactive) 
LTJG Theodore B. Van Itallie (MC) USNR (Inactive) 
LT James P. Walsh (MC) USNR (Inactive) 
LTJG William P. Walsh (MC) USNR (Inactive) 

American Board of Neuropsychiatry 

LT Phillip R. Apffel (MC) USNR (Inactive) 

American Board of Neurological Surgery 
LCDR Emil P. Thelen (MC) USN 

American Board of Obstetrics and Gynecology 
LT Robert J. Staub (MC) USNR (Inactive) 

American Board of Ophthalmology 

LTJG Vincent O. Eareckson, Jr. (MC) USNR (Inactive 
LT Stanley Masters (MC) USNR (Active) 

American Board of Orthopedic Surgery 

LT Thomas R. Miller (MC) USNR (Inactive) 

American Board of Otolaryngology 

LTJG Robert Z. Berry (MC) USNR (Inactive) 

American Board of Pediatrics 

LT Marvin P. Baecker (MC) USNR (Inactive) 

LT John A. Bishop (MC) USNR (Inactive) 

Lt Joseph M. Perret, Jr. (MC) USNR (Inactive) 

American Board of Psychiatry and Neurology 

LTJG Zack Russ, Jr. (MC)USNR (Inactive) 
LT Charles W. Wahl (MC) USNR (Active) 
LT James H. Wells (MC) USN 

American Board of Radiology 

LT John E. Aiken (MC) USNR (Inactive) 
LT Donald N. Dysart (MC) USNR (Inactive) 



Medical News Letter, Vol. 25, No. 4 27 



American Board of Surgery 

LT Robert E. McAlpine (MC) USNR (Inactive) 
LCDR Milton R. Porter (MC) USNR (Inactive) 
CDR Ronald N. Shelley (MC) USNR (Inactive) 
LT Robert B. White (MC) USNR (Active) 
LT Irvan Zeavin (MC) USNR (Active) 

American Board of Urology 

LT Richard J. Spillane (MC) USNR (Inactive) 

Recent Research Projects 



Naval Medical Research Institute, NNMC, Bethesda, Md. 

1. Effect of Snail Maintenance Temperatures on Development of Schistosoma 
Mansoni. NM 005 048.02. 31, 17 Aug 1954. 

2. Some Further Observations on the Interaction of EDTA with the Myosin- 
ATP System. NM 000 018.04, Memorandum Report 54-8, 17 Aug 1954. 

3. Dose Dependence and Sequential Changes in Mouse Small Intestinal 
Weight Induced by Ionizing Radiation. NM 006 012. 04. 70, 21 Sept 1954. 

4. The Protective Effect of Granulocytes in Radiation Injury. Lecture 
and Review Series No. 54-4, 7 Oct 1954. 

5. A Splash Trap. Memorandum Report 54-9, NM 000 018. 07, 12 Oct 1954. 

6. The Determination of Human Body Surface Area from Height and Weight. 
NM 004 006. 05.01, 19 Oct 1954. 

7. Infectivity of Rickettsia Tsutsugamushi - Infected Yolk Sac Suspensions 
after Storage for Varying Time Intervals. NM 005 002. Report No. 10, 
22 Oct 1954. 

8. A Proteolytic Inhibitor with Anticoagulant Activity Separated from Human 
Urine and Plasma. NM 006 012. 04. 77, 26 Oct 1954. 

9. Simple Clamp for Arterial Anastomosis. Memorandum Report 54-10. 
NM 000 018. 07, 1 Nov 1954. 

10. The Visibility of Airport Runways. NM 001 056.07. 03, 15 Nov 1954. 
Naval Medical Research Unit No. 3, Cairo, Egypt 

1. The Herpetology of Sinai. Research Report NM 005 050. 39. 38. 

2. Recto Sigmoid Polyps in Schistosomiasis. I. General Clinical and 
Pathological Considerations. NM 007 082. 24. 01. 

3. A Regional Reconnaissance on Yellow Fever in the Anglo -Egyptian 
Sudan. NM 005 050. 39. 39. 



28 



Medical News Letter, Vol. 25, No. 3 



Naval Air Development Center, Johnsville, Pa. 

1. Summary Review of the Influence of Thermal Radiation on Human Skin. 
NM 001 090. 04.04, 10 Nov 1954. 

2. Accomplishment Summary of Aviation Medical Acceleration Laboratory. 

Naval Medical Field Research Laboratory, Camp Lejeune, N. C. 

1. The Hemodynamic Response to Thermal Radiation, NM 006 014. 04. 02, 
December 1954. 

Medical Research Laboratory, Submarine Base, New London, Conn. 

1. Effects of Prolonged Exposure to 1.5% Carbon Dioxide in Air for Periods 
up to 91 Days on Body Weight, Carbohydrate Metabolism, and Adrenal 
Cortical Activity in Guinea Pigs. NM 002 015. 11. 05, 12 Oct 1954. 

2. Report of Tests on the Use of Dry Imitation Vinegar on Submarines. 
Memorandum Report No. 54-12, NM 002 015. 13. 01. 7 Dec 1954/ 

$ jj: $ $ Sis & 



BUMED NOTICE 6780 



27 December 1954 



From: Chief, Bureau of Medicine and Surgery 

To: Ships and Stations Having Medical /Dental Personnel Regularly 

As signed 

Subj: Protective Clothing Set, Chemical Warfare Agents FSN 

6545-925-1695 (Indented) (Component of Medical Supply and 
Protective Clothing Set, Gas Casualty Treatment FSN 
6545-924-5675) 



Ref: 



(a) BuSandA Manual, Volume 4, paragraphs 42750 through 42773 



This Notice invites attention of cognizant personnel to requirement for 
examination of component item Outfit, Clothing, Impregnated, Chemical 
Defense, 10-man Outfit, SN S37-0-92-250 contained in subject set. 



BUMED INSTRUCTION 6710. 12 



6 January 1955 



From: Chief, Bureau of Medicine and Surgery 
To: All Ships and Stations 



Subj : 



Defective medical and dental materialjauthority for disposition of 



Medical News Letter, Vol. 25, No. 4 



29 



Ref: (a) Medical and Dental Materiel Bulletin, Edition No. 49 
dtd 1 Dec 1954 
(b) Art. 25-21, ManMedDept 

This Instruction provides authority for the disposal of defective material 
listed in paragraph IV of reference (a). 

$ sj! sje $ $ sjt 

BUMED NOTICE 6150 10 January 1955 

From: Chief, Bureau of Medicine and Surgery 

To: All Ships and Stations Having Medical Personnel Regularly 

As signed 

Subj : NavMed-H-10 (Sick Call Treatment Record); preparation and 
retirement of 

Ref: (a) Chap 16, Sec XVI, ManMedDept 

(b) BuMedlnst 6150.10 re DD Form 689 and NavMed-H-10 

This Notice is promulgated to emphasize the importance of recording 
appropriate entries on NavMed-H-10 for each individual examined or 
treated; to further insure that each member's NavMed-H-10 is removed 
from the files of Sick Call Treatment Records and secured in the Health 
Record upon transfer; and for the prompt retirement of the form in accord- 
ance with Chapter 16, ManMedDept, and other current directives. 

jj' !$! >jc >Ji 3^£ 

BUMED NOTICE 6300 17 January 1955 

From: Chief, Bureau of Medicine and Surgery 

To: All Ships and Stations Having Medical, Dental, and/or Nurse 

Corps Officers Regularly Assigned 

Subj: Cancer information for Medical, Dental, and Nurse Corps officers 

End: (1) List of Division Offices, American Cancer Society 

This Notice informs addressees of material available from the American 
Cancer Society. The material should be of value in keeping professional 
personnel aware of current developments in cancer research, diagnosis, 
and treatment. 

ije sje $ iff 3(c $ 



i 



30 



Medical News Letter, Vol. 25, No. 4 



BUMED INSTRUCTION 6320. 9B 20 January 1955 

From: Chief, Bureau of Medicine and Surgery 

To: All Ships and Stations Having Medical Personnel Regularly 

Assigned 

Subj: Outpatient Report, DD Form 444 

This Instruction revises instructions for the preparation and submission 
of subject report in order to comply with instructions recently issued by 
the Department of Defense which now requires the reporting of outpatient 
visits. 

BuMed Instruction 6320. 9A is canceled. 

The printing of this publication has been approved by the Director of 
the Bureau of the Budget, June 2 3, 1952. 

****** 
AVIATION MEDICINE DIVISION 




3.5 IN '55 

An Aviation Safety Planning Guide for 1955 has been prepared by 
the U.S. Naval Aviation Safety Activity (NASA), Norfolk, Va. , and dis- 
tributed to all naval aviation safety officers to assist in planning and carry- 
ing out a sound aviation safety campaign for 1955. It behooves all flight 
surgeons attached to aviation operational units to procure and study this 
planning guide and to assist in the safety campaign. 

Significant progress has been made in reducing the all-Navy major 
aircraft accident rate from 5. 2 in calendar 1953 to approximately 4. 6 in 



Medical News Letter, Vol. 25, No. 4 



31 



1954. The target rate for 1955 is 3. 5, or a ratio of 3-1/2 accidents per 
10,000 flying hours. 

The campaign calls for emphasis on the aeromedical aspects of 
accident prevention during the month of March 1955. The following is 
quoted from the Guide: 

"This month is devoted to one of the most important phases of an 
accident prevention program but one which often receives the least atten- 
tion. One cannot overemphasize the roles played by physiology and psy- 
chology in aircraft accidents. The fact that nearly 65% of the accidents are 
classed as pilot-caused should be sufficient to convince any aviator that 
these are fertile areas for an accident prevention program. " 

Let us repeat for emphasis - -approximately 65% of aircraft accidents 
in the U. S. Navy are attributed to pilot error. A large percentage of these 
accidents could have been prevented if the pilot had known more about the 
functioning of his body and his mind. It is considered particularly signifi- 
cant that the emphasis should be on the pilot as a human being. 

A great deal of the effort of the aviation safety campaign for March 
will be in the flight surgeon's field, but the aviation safety officer can do 
much to coordinate the effort. Lectures should be scheduled, covering 
such topics as (1) physical fitness; (2) the effects of fatigue, (3) alcohol, 
carbon monoxide, and hypoxia; (4) hyperventilation; (5) the psychology of 
errors; and (6) the importance of anxiety and confidence, and the importance 
of talking to the flight surgeon about domestic problems, minor ailments 
such as headaches or colds, and any problem about which the pilot is con- 
cerned. 

Emphasis should be placed on the fact that any personal problem 
that arises will affect the pilot's ability to control an aircraft adequately, 
and that these problems should be brought to the flight surgeon for both 
evaluation and solution. The unit flight surgeon must be more than a 
doctor; he must act as father-confessor, a guiding light in the field of 
finance and romance, and, even at times, a stern taskmaster in lectur- 
ing to the wayward youngster on the evils of "wine, women, and song. " 
No problems or ailments should be too small or too large for the pilot 
to discuss freely with "his" flight surgeon. In turn, the flight surgeon 
must make himself available for such consultation. He should never be 
"too busy" to take time to listen and give advice. The flight surgeon 
"belongs" to a unit; and by that very fact, he is "possessed, " as it were, 
by each member of that unit. 

During the month of March, efforts toward aviation safety by the 
flight surgeon can probably best be broken into two portions - -the physio- 
logical and the psychological phases. Obviously, there is a great deal of 
overlap in these areas, but for the sake of planning a program, they can 
best be handled separately. 

The first or physiological phase should cover the following broad 
subjects: (1) normal human physiology; (2) atmospheric physics; (3) high 



32 



Medical News Letter, Vol. 25, No. 4 



altitude flight physiology; (4) the special senses as related to flight problems 
(5) fatigue and effects of alcohol, drugs, and illness as related to flight effi- 
ciency; and (6) the purpose and uses of airborne personnel equipment. 

Every effort should be made to schedule all aviators who have not met 
the requirements of OPNAV INSTRUCTION 3740.3 to be put through a low 
pressure chamber run. Those who have not gone through the night vision 
training course within the past 2 years should be scheduled for that training, 
and all pilots riding the ejection seat should receive a yearly lecture and 
film showing and should have had at least one shot on the ejection seat 
trainer device. It is the flight surgeon's obligation to review each pilot's 
health record periodically and notify the unit's commanding officer of any 
pilot's failure to be currently trained in aviation physiology. The flight 
surgeon should advise as to the fitting of oxygen masks, "G" suits, and 
helm ets. 

The second phase pertaining to the psychology of flight and, conse- 
quently, the psychological aspects of accident prevention is not an easy 
subject and, more than likely, will require a good deal of time in the read- 
ing of source material for preparation. Talks covering this field must 
necessarily cover the psychologies of learning, error, fear, and confi- 
dence. There are factors such as distractions by worries, carelessness 
by overconfidence, abstractiveness or daydreaming, and even the psycho- 
logy of just "doping off. " The question of what makes a pilot so energetic 
at an "O" club, dance and so downright lazy when it comes to learning about 
his aircraft can well be a subject of discussion in the psychological phase 
of his training. 

A number of good motion pictures are available to the flight surgeon 
to aid him in training the pilot. Here are a few of them: 

1. "Fly High and Live" - MN-2860 (1944, B&W, 28 min. ) 

2. "G and You" - MN-236 1 ( 1945, color, 44 min) 

3. "Night Vision for Airmen" - MN-3462 (1945, B&W, 20 min. ) 

4. "Highspeed, High Altitude Flight Problem s - -Physiological" 

MN-6915A (color, 24 min) 

5. "Emergency Escape Using the Ejection Seat" MN-93I3 New. 
A number of new publications, a few of which are listed below, can 

give the flight surgeon a great deal of lecture material: 

1. "Naval Aviation Night Vision Instructor's Manual" - 

NavMed P-5006 

2. "Instructor's High Altitude Physiology Training Manual" - 

NavExos P-1260 

3. "Safety and Survival Equipment for Naval Aviation" - 

NavAer 00-80T-52 

4. "Aviation Medicine Practice" - NavPers 10839 

5. "Instructors Manual for Physiological Training" - 

Air Force Manual 52-13 



Medical News Letter, Vol. 25, No. 4 



33 



6. "Physiology of Flight" - Air Force Manual 160-30 

7. "Handbook for Survival Training and Personal Equipment 

Personnel" - Air Force Manual 64-4 
The ultimate aim for the month of March 1955 should be to provide 
each naval pilot with the maximum amount of aviation psycho-physiological 
information and training in order that he will be better able to understand 
himself, his equipment, and his place in the Navy- -in general, to make 
him a healthy, well adjusted, better informed, "bright-eyed and bushy- 
tailed, " ready-to-go pilot. Let's get the flight surgeon back to practicing 
"honest-to-goodness" aviation medicine on a sound, down-to-earth basis, 
and in this way, have the pilot and aircrewmen eagerly turn to him for help 
and information. 

The flight surgeon can go far in the accident prevention program; 
much farther than most of us realize. But it takes work and effort, A good 
safety record doesn't just happen- -its caused, yes caused, by the concerted 
effort of all members of a unit; and a very large segment of a unit's acci- 
dent prevention responsibility belongs to the flight surgeon. If you do your 
job well, you will see the results; if you don't do your job, you'll see the 
statistic s. 

>Jc s]c sQs sjc jjt 

C ertification in Aviation Medicine 

The first examination by the American Board of Preventive Medicine 
in Aviation Medicine for certification of board eligible aviation medicine 
specialists will be given just prior to the 26th annual meeting of the Aero 
Medical Association in Washington, D. C. , this coming March. The exam- 
inations will be given on the 17th, 18th, and 19th of March 1955, and will 
consist of three distinct sections. One will be a written examination in 
Preventive Medicine. The second will be in Aviation Medicine and will 
also be a written examination. The third will be an oral interview type 
of examination. As of this date, no information concerning the fields to 
be covered in the oral examination is available; however, it is safe to 
assume that the test will be of an unlimited scope and will consist of both 
Preventive Medicine and Aviation Medicine problems. 

For the written Preventive Medicine examinations, subjects will 
cover such fields as (1) Biostati stic s, involving theory, methodology, 
records, and reports; (2) Epidemiology; (3) Environmental medicine; 

(4) Ecology, including microbiology, chemistry, biophysics, and sociology; 

(5) Environmental control which includes accident prevention, industrial 
hygiene, nutrition, and community hygiene; (6) Physiological hygiene; 

(7) Clinical Preventive Medicine including mental and oral health, rehabili- 
tation, and geriontology; (8) Toxicology; and (9) Preventative psychology. 



34 



Medical News Letter, Vol. 25, No. 4 



The consensus is that a thorough review of "Preventive Medicine 
and Hygiene, " edited by Maxey, and "Preventive Medicine and Public 
Health, " by Smillie, will prove to be a very decisive adjunct to those pre- 
paring to take this examination. Undoubtedly, all those who are anticipat- 
ing this examination have some degree of familiarity with all of the subject 
matter listed; however, it seems reasonable that an extensive review of 
at least Maxey's book and perhaps Smillie 1 s volume is highly advisable 

Another valuable reference is the "Control of Communicable Disease 
in Man, " published by the U. S. Public Health Service. A review of some 
of the more important communicable diseases , such as tuberculosis, the 
venereal diseases, malaria, et cetera, in this volume, along with "brush 
up" on the clinical aspects of these diseases in any standard internal med- 
icine textbook, will be of value to those being examined. 

For those who wish to delve further into the subjects related to bio- 
metrics and reporting, it will be of help to review Bradford Hill's volume, 
"Principles of Medical Statistics" {Oxford, 1950). A chapter on statistical 
method s in "Genetics and the Races of Man, " by W. C. Boyd, (Little, Brown 
and Company, 1950) is an excellent short review of the subject. Another 
valuable reference is the 10th edition of the "Physicians Handbook on Death 
and Birth Registrations, " by the U. S. Public Health Service, 1949. This 
handbook can be obtained for 15£ by writing to the Superintendent of Docu- 
ments, Washington 25, D. C. 

Many references are of valuable assistance to those who wish to refer 
to them, but none are to be considered as "musts" for review. Among 
them is the "Introduction to Public Health, " by Mustard, 1952, which con- 
tains an interesting and highly informative chapter on the history of Pre- 
ventive Medicine. Another is "How to Lie with Statistics, " by Darrell 
Huff, and published by Norton, 1954. This volume emphasizes the misuse 
of statistical methods and thus conveys considerable understanding in the 
process. "The Eleven Blue Men, " by Berton Boueche, published in 1954 
by Little, Brown and Company, is a collection of true stories concerning 
epidemiological detective work. 

The following books and periodicals are excellent, and can be of 
assistance to those who refer to them: 

1. "Essentials of Public Health, " William P. Shepard, M.D. , 

published by Lippincott. 

2. "Viral and Rickettsial Infections of Man, " Thomas N. Rivers, 

M. D, , Lippincott. 

3. "Bacterial and Mycotic Infections of Man, " Rene J. Dubos, 

M. D. , Lippincott. 

4. "Journal of the American Public Health Association" 

5. "Public Health Reports of the Public Health Service" 

The section of the examination dealing with aviation medicine should 
not prove to be very difficult to board eligible members of the U. S. Navy 



Medical News Letter, Vol. 25, No. 4 35 



and Air Force. Aviation medicine practice in the armed services brings 
one in contact with all phases of the specialty and keeps active duty flight 
surgeons up with the latest developments in aeronautical research develop- 
ment, equipment, and advanced problems. However, it behooves each 
candidate for the boards to seriously review the history of aviation medicine 
and aviation physiology, and study intensely the problems that are present 
in the operations of commerical airlines --problems such as ground person- 
nel safety and working conditions, and management-labor relations. One 
should know all the names of important contributors to aviation medicine 
from the earliest investigator, who studied the effects of reduced atmos- 
pheric pressures in balloons, to the latest scientists who are presently 
recognized as leaders in this newest of specialties. 

The examination in aviation medicine will deal in many phases of 
the specialty and will cover {1) basic sciences as applied to aviation med- 
icine, particularly dealing with anatomy, physiology, biophysics, chemistry, 
pathology, and statistics; (2) preventive medicine as applied to aviation, 
including epidemiology, accident and disease prevention and control, and 
sanitation; (3) flight medicine, including altitude indoctrination, health 
supervision, escape and survival, personnel equipment, and the diagnosis, 
treatment and rehabilitation of aviation personnel; (4) aviation psychology, 
including selection and training of personnel; (5) the development and usages 
of flight equipment; (6) the special senses and physiological reaction to un- 
usual flight situations; and (7) administrative problems in personnel relation- 
ship, principles, standards, legal aspects, and management in the airlines 
industry. 

Reviews of Armstrong's "Aviation Medicine" and White and Benson's 
"Physics and Medicine of the Upper Atmosphere" will give the candidate a 
basic refresher in general aviation medicine, and a profound study of 
McFarland's "Human Factors in Air Transportation" will give a detailed, 
fundamental, and authoritative knowledge of many aviation medicine problems 
not evident to the military flight surgeon. 

Many manuals are published by the U.S. Navy and Air Force that 
contain valuable information and could well be reviewed. Most of them are 
obtainable on a loan basis at one of the aviation physiology training units 
of either service. Some are listed below: 

1. USN - "Instructor's High Altitude Physiology Training 
Manual" NavExos 1260. 

2. USN - "Naval Aviation Night Vision Instructor's Manual" 
NavMed P-5006. 

3. USN - "Safety and Survival Equipment for Naval Aviation" 
NavAer 00-80T-52. 

4. USN - "Aviation Medicine Practice, 11 1955, NavPers 10839. 

5. USAF - "Physiology of Flight" Air Force Manual 160-30, 

6. USAF - "Your Body in Flight" Air Force Manual 51-7. 



36 



Medical News Letter, Vol. 25, No. 4 



7. USAF - "Instructors Manual for Physiology Training" 
Air Force Manual 52-13. 

8. USAF - "Handbook for Survival Training and Personal 
Equipment Personnel" Air Force Manual 64-4. 

The listing of the many references found in this article was not done 
with any intention of advising candidates that all, or even the majority of 
these publications should be studied. The reason for the large listings 
is to give as wide a choice of reading as possible to the candidate. In 
the final analysis, the three most important volumes are: 

1. "Preventive Medicine and Hygiene" by Maxey. 

2. "Aviation Medicine" by Armstrong. 

3. "Human Factors in Air Transportation" by McFarland. 

It is hoped that all those U.S. Naval flight surgeons who have been 
found board eligible will, at some time in the near future take the examina- 
tion in aviation medicine and become board members. Following the exam- 
inations in March, it will be possible to promulgate more specific informa- 
tion concerning the examinations. Those desiring added information for the 
immediate future concerning the examinations, dates, et cetera, should 
write to Ernest L. Stebbins, M. D. , Secretary- Treasurer , American Board 
of Preventive Medicine, Inc. , 615 North Wolfe Street, Baltimore 5, Md. 

* T * * * ^ 

1955 Aero Medical Association Meeting 

The 26th annual meeting of the Aero Medical Association will be held 
on 21-22-23 March 1955, in the Hotel Statler, Washington, D.C. Many of 
you are familiar with the magnificent accommodations the convention and 
its exhibits have at the Hotel Statler from attending meetings there in 1952 
and again last year. 

This year's meeting will undoubtedly surpass all previous meetings 
in interest and attendance. One of the big attractions will be the First 
Louis H. Bauer Lecture that will be given by John F. Fulton, M. D. , 
Sterling Professor of History of Medicine at Yale University. His talk 
will be "Louis H. Bauer and the Rise of Aviation Medicine. " This lecture 
will be the opening event of the meeting and will be followed for the next 
three days by the finest array of professional papers dealing with aviation 
medicine that has ever been brought together on one program. 

A special session on Space Medicine will be held at 2:00 p.m. on 
21 March. A showing of the latest films will deal with aviation medicine 
and other aviation problems each morning and afternoon in an especially 
appointed movie room. The annual business luncheon will be held on Tues- 
day noon, 22 March, and the annual "Honors Night" Reception and Dinner 



Medical News Letter, Vol. 25, No. 4 



37 



will climax the meeting on Wednesday night, 23 March. The Honorable 
Stuart Symington, United States Senator from Missouri, will be the guest 
of honor and principal speaker at the dinner. 

The Fellows' Group will make their selection of new members at 
their annual reception and dinner on Monday night, 21 March. 

The Wives' Wing has scheduled a full three days for their members 
and lady guests. There will be a sponsored welcoming tea and fashion 
show at 3:00 p.m. .Monday, 21 March, in the Hotel Statler. The Wing's 
annual luncheon and business meeting will also be sponsored and will be 
held in the South American Room of the Hotel Statler at 12:30 p. m. , Tues- 
day, 22 March. On Wednesday, there will be an Embassy Tour that will 
take the ladies into a number of the finest and most exotic embassies in 
Washington. 

No one interested in aviation medicine can afford to miss this meet- 
ing. Incidentally, this is the last time the meeting will be held in Washing- 
ton, D. C. , for several years to come. 

Of interest to U.S. Naval flight surgeons will be the below listed 
professional papers to be read by U.S. Navy representatives during the 
scientific sessions of this meeting: 
Monday, 21 March, 2:40 p.m. 

"The Biological Significance of the Natural Background of 
Ionizing Radiation at Sea Level and at Extreme Altitude" by 
Hermann J. Schaefer, Ph. D, , U.S. Naval School of 
Aviation Medicine, Pensacola, Fla. 
Tuesday, 22 March, 9:00 a.m . 

"The Design and Evaluation of Aviation Protective Helmets" 
by Edward M. Wurzel, CDR (MC) USN, U.S. Navy Aeronautical 
Medical Equipment Laboratory, Philadelphia, Pa. 
Tuesday, 22 March, 9:20 a.m . 

"Escape from Vertical Take-Off Type Aircraft" by Roland A. Bosee, 
CDR (MSG) USN, and W. C. Buhler, B. S. , U.S. Naval Parachute 
Unit, El Centro, Calif. 
Tuesday, 22 March, 11:40 a.m . 

"Aircraft Accidents with Happy Landings" by Richard B. Phillips, 
CAPT (MC) USN, U. S. Naval Medical School, Bethesda, Md. 
Tuesday, 22 March, 3:00 p.m . 

"The Problem of High Intensity Noise at a Jet Air Base and Some 
Suggested Solutions" by Kenneth S. Scott, CDR (MC) USN, U.S. 
Naval Air Test Center, Fatuxent River, Md. 
Wednesday, 23 March, 9:20 a.m . 

"An Analysis of Methods of G-Protection" by David H. Lewis, 
LT (MC) USNR, Aviation Medical Acceleration Laboratory, 
U.S. Naval Air Development Center, Johnsville, Pa. 



38 



Medical News Letter, Vol. 25, No. 4 



Wednesday, Z3 March, 9:40 a.m . 

"Aviator's Oxygen Breathing Devices; Transition to Variable 
Integrated Systems" by Aaron Bloom, B. S. , U. S. Navy 
Aeronautical Medical Equipment Laboratory, Philadlephia, Pa. 
Wednesday, 23 March, 10:00 a.m . 

"Oxygen Want-Warning Systems for Military Aircraft" by 
Edward L. Michel, M.S., U.S. Navy Aeronautical Medical 
Equipment Laboratory, Philadelphia, Pa. 
Wednesday, 23 March, 12:00 noon 

"Current Developments in Improving Informational Presentations 
for the Navy Pilot" by Fred R. Brown, M.S. , U. S. Navy Aero- 
nautical Medical Equipment Laboratory, Philadelphia, Pa. 
Wednesday, 23 March, 2:20 p.m . 

"Simplifying the Pilot's Task Through Display Quickening" by 
Franklin V. Taylor, Ph. D. , and Henry P. Birmingham, A. B. , 
Naval Research Laboratory, Washington, D. C. 
Wednesday, 23 March, 2:40 p.m . 

"A New Look for Aircraft Instrumentation" by George W. Hoover, 
LCDR USN, Office of Naval Research, Washington, D. C. 

* * % * $ * 
Attention! ! West Coast Flight Surgeons! 

All those flight surgeons on or near the West Coast will be able to 
"book" roundtrip air transportation to and from the 26th annual meeting of 
the Aero Medical Association to be held in Washington, D. C. , 21, 22, and 
23 March, 1955. 

A second section of the eastbound MATS Flight D-73 will leave the 
Naval Air Station, Moffett Field, Calif. , Sunday, 20 March, and will stop 
at Travis Air Force Base, Fairchild, Calif. , for a passenger stop before 
flying nonstop to Andrews Air Force Base, Washington, D. C. A westbound 
MATS flight will leave MATS Operations, Andrews Air Force Base, Wash- 
ington, D.C. , Thursday, 24 March, for a nonstop flight to Travis Air Force 
Base, and thence to the Naval Air Station, Moffett Field. 

All flight surgeons of the West Coast area are urged to utilize this 
means of transportation in attending the 1955 Aero Medical Association 
meeting. Please contact the MATS traffic representative of either the 
Naval Air Station, Moffett Field, or Travis Air Force Base as early as 
possible, making certain the representatives are informed that the purpose 
of your trip is to attend the Aero Medical Association meeting. The MATS 
passenger service at either field will inform you of take-off times and other 
pertinent details. The MATS traffic representatives at Andrews Air Force 
Base will handle all reservations for the return flight to the West Coast. If 
possible, these return reservations should be made at the time of arrival 
from the West Coast. Y'all come now! 



Medical News Letter, Vol. 25, No. 4 39 

Defects Noted on SF-88's and SF-89's Submitted to BuMed 
December 1954 and January 1955 

102 

Excess copies 

11 

Lack of copies 

Copies not legible 2 

Original and copies dissimilar 6 

Item 2. No designator here or elsewhere 1 

Item 6. Date of examination omitted . 2 

Item 11. Organizational unit omitted 3 

Item 12. Birth date omitted or in error 9 

Item 15. Examining facility omitted 6 

Item 17. Aviators flight time omitted 58 

Item 45. Urinalysis omitted 3 

Item 46. Chest x-ray omitted 2 

Item 51. Obvious errors in height 3 

Item 52. Weight omitted or in error 1 

Item 57. C.E.R. omitted 2 

Item 57. Blood pressure omitted 2 

Item 58. Pulse omitted 2 

Item 59. Distant vision omitted 5 

Item 60. Refraction not properly recorded 4 

Item 60. Refraction omitted on NavCad applicants . 4 

Item 62. Omitted in full 9 

Item 62. Right or left heterophoria omitted • » 1 

Item 62. P. D. at 13" omitted 30 

Item 62. P. D. at 20 1 omitted 20 

Item 62. P. C. and P. D. omitted 9 

Item 63. Accommodation omitted 10 

Item 64. Color vision omitted ■ 1 

Item 65. Depth perception omitted 9 

Item 66. Field of vision omitted 56 

Item 69. Intraocular tension omitted 58 

Item 70. Hearing omitted 2 

Item 71. Audiometer omitted on NavCad applicants 7 

Item 73. No reason given for hospitalization 4 

Item 73. Not leaving space for BuMed endorsement 12 

Item 73. Not enough detail on physical defects 1 

Item 77. Failure to state aviator's service group- 12 

Items 79 through 82. No signatures 2 

Failure to evaluate on SF-89 3 

Failure to complete Item 21 on SF-89 7 



# >;< * * # ^ 



40 



Medical News Letter, Vol. 25, No, 4 
Aviation Medicine Practice - NavPers 10839 



A new revised edition of the Aviation Medicine Practice, NavPers 
10839, will be off the presses by the time this News Letter reaches its 
readers. This 1955 edition is a complete revision of the 1949 model and 
will contain 282 pages of script and illustrations. It is considered to be 
the latest and most complete general text on naval aviation medicine and 
will be utilized as the reference text for the U.S. Navy Medical Depart- 
ment's correspondence course, Aviation Medicine Practice, Q-20. 

All flight surgeons interested in receiving a copy of this edition 
may do so by addressing a letter request to the Chief of the Bureau of 
Medicine and Surgery, Aviation Medicine Division (Code 536), 
Navy Department, Washington 25, D. C. 

****** 



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